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Glutathione Survey

Fields marked with * are required.
 

General Contact Information

* First Name:

 

* Last Name:

* Email:

   Phone:

   City:

   State/Zip:

/ 

 

Would you like to receive informational and promotional e-mails from Wellness Health?

Yes

No

 

   

Which of the following best describes you?

* I am a:

Parent

 

GSH user

 

Healthcare practitioner

 

Other

How did you learn about Essential GSH®?


Essential GSH® User Information

User Name:

 

User Age:

 

Please describe the condition for which you are using Essential GSH®:

Your symptoms include:

How long have you been using Essential GSH®?

Please tell us (in detail) about any improvement noticed:

How many teaspoons of Essential GSH® were you taking per day when you started noticing improvement?

How long do you plan on using Essential GSH® as part of your treatment?

Which (if any) other forms of glutathione are you currently taking? Please select all that apply. Note: Hold down the Ctrl key to select multiple options.

How long (for each)?

How many teaspoons of Essential GSH® are you taking for maintenance per day?

Describe any liquids (i.e. orange juice) used for ingestion and how each tasted:

Would you recommend Essential GSH® to others?

yes

no

  

   

May we call you to discuss your answers to our survey?

yes

no

Please share with us any additional comments you may have about Essential GSH®, Wellness Health, etc.:

May we post your comments on our website?

yes

no

 
  

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